Introduction.
                 Healthcare reform is generally a policy and operational change to a health system. The recent US Healthcare bill has been endorsed allowing President Obama some well deserved leave.
                Effectively this will mean an attempt at “universality” of health cover with an additional 31 million people receiving medical care. In a country which is held as most developed, over 47 million remain out of the range of medical cover, currently.
                Healthcare also consumes 16% of the US GDP. Therein lays the difficulty to deal with cost control. Spiralling upwards “Cost” includes that of the health practitioners and newer technology which need urgent addressing simultaneously with “Universality” issues. The forces in play make health politics quite sick.
                The anticipated timeline to implementation will be 2014 and will mean everybody needs to take out medical insurance as mandated or face fines. The issues of public versus public /private insurance also need addressing.
This brings to surface “individual choice”, Human rights.
Is health a right or is it a choice, remains debate-able?

                 Our health reform which took root in 2009 has its own issues which are being addressed according to our national needs without delay. With fewer than 3% of the GDP we have had universality of cover, unlike USA. Our cover needs to raise its standards several fold to be worthy of praise. The first steps have been undertaken. 
                 However to spearhead a streamlined, efficient level of care ,along with strengthening the tier system of health delivery (primary care strengthening) we have taken the care to the people in 2009 (patient centeredness and specialist outreach).We have not waited but simultaneously advanced on new policy and operational redirection  without the comfort of taskforces, scoping, strategising prior to operations.
                There are competing financial and human resource demands in any country. Each subgroup has had their priorities.

The Public’s Demand.
At the outset the pharmaceutical lines were most pressing with outages of medication; consumables and the lead time to receive these essentials at the health outposts were matters which needed urgent streamlining. A revitalised system to procure, store and distribute these items had brought relief to both practitioners and patients alike. Sourcing generic pharmaceuticals and consumables have had their high points especially with the global recession.

The long waiting times at our Accident/Emergency units at base hospitals were a matter of concern. With extended hours at the peripheral health centres, the base hospitals felt the respite and started coping a little better. External Audits of Outpatient services have been conducted at the CWM Hospital, a sure sore point for many clients. Issues to address have included grumpy nurses and short fused doctors. Least of all the dirty toilets will be something of the past as $100,000 is being spent to refurbish the conveniences currently.

The Hospitals developed new facilities which are essential for tertiary units in the form of The Cardiac Catheterisation Laboratory and the Regional Pacific Eye Unit is taking shape at CWM hospital, Suva. The Eye Clinic is the recipient of the latest Laser machines and retinal cameras which are operational by our local experts. The Cardiac Laboratory has already undertaken Angiograms in just under 30 patients and is poised for progress onto Stenting by February 2010 and undertakes Balloon Angioplasty by June 2010.